The Coordinator, Pharmacy Revenue Integrity responsible for reviewing, auditing and reporting on charge capture at the department level, completing charge reconciliation, analyzing and resolving claims' denials and unbilled claims' issues, performing audits on department patient accounts, supporting Revenue Integrity initiatives on behalf of the department, and ensuring billing compliance.
Action oriented - Taking on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm.
Customer focus- Building strong customer relationships and delivering customer-centric solutions.
Communicates effectively- Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.
Decision quality- Making good and timely decisions that keep the organization moving forward.
Collaborates- Building partnerships and working collaboratively with others to meet shared objectives.
Nimble learning- Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.
Demonstrates self-awareness- Using a combination of feedback and reflection to gain productive insight into personal strengths and weaknesses.
· Reviews, audits and reports on departmental charge capture, performs charge reconciliation on a regular basis, and works closely with department staff on timely charge capture
Performs timely reviews of patient accounts and remittances for denials in order to determine root cause and appropriateness, and leads corrective action plans
Analyzes and resolves claims' denials and unbilled claims, including posting debits and credits to patient accounts
Facilitates selection of patient encounters for review prior to and after patient billing for purposes of performing audits and verification of billing compliance
Performs various analysis and provides reports to determine trends, compliant billing, impact to net revenue, and other analytical requests pertaining to revenue cycle
Works in concert with Revenue Management Team members and Revenue Integrity team at the hospital to ensure timely gathering and reporting of applicable data
Interacts and works with Revenue Cycle departments (i.e. HIM, Patient Access, PFS, and Compliance) on revenue management initiatives and process improvement opportunities
· Performs other duties, as assigned by Department Manager or Director
POSITION SPECIFIC COMPETENCIES
o Contributes to the quality and effective operation of the department.
o Is punctual and dependable; reports to work as scheduled. Absenteeism and tardiness are within policy guidelines.
o Maintains a neat, professional, well-groomed appearance. Wears identification badge.
o Performs work within specified timeframes. Adapts positively to frequent interruptions and changes in workload and/or work schedule.
o Provides courteous, cooperative and timely service to patients, visitors and staff. Demonstrates good verbal and written communication.
o Works cooperatively with hospital and pharmacy staff. Voices concerns and suggestions to appropriate persons in a positive manner. Fosters a team environment.
o Demonstrates sound professional judgment consistent with clinical/academic background.
o Maintains strict confidentiality of patients, guests and employee information.
o Complies with all requirements related to risk management, safety, security, fire and infection control.
o Adheres to hospital and departmental policies and procedures. Complies with all applicable Federal and State laws, rules and regulations.
o Works independently with minimal supervision. Organizes and prioritizes work assignments. Ensures pharmacy services are provided in a timely manner.
o Answers the telephone, identifying self and department. Directs calls to appropriate personnel. Answers requests at the window.
o Keeps pharmacy areas and equipment clean, neat and well organized.
· Bachelor's degree in Business or Healthcare related field preferred.
· Computer proficiency in Microsoft business programs.
· Intermediate to Advanced level in Microsoft Word and Excel
· Strong knowledge of healthcare revenue cycle processes and Federal, State and local insurance guidelines and regulations.
· Minimum of three (3) years working in healthcare, whether in a clinical or ancillary setting or a Revenue Cycle department, is highly preferred.
· Thorough understanding of outpatient pharmacy billing, payer contracts and reimbursement rates, and other revenue cycle functions.
· Working knowledge of Infor, Bank of America CashPro, cash management, and systems applicable to the department. Demonstrated ability to function in an independent manner at a high performance level
· Demonstrated ability to function as part of a team
· Demonstrated ability to coordinate activities to achieve objectives and implement plans
· Demonstrated high level of attention to detail
· Requires a high degree of self-direction, priority setting and independence
· Demonstrated ability to communicate effectively, both verbally and in writing
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.